Provider Demographics
NPI:1760972426
Name:ACHA, SIMON NKE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:NKE
Last Name:ACHA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 E STATE ST STE 360
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4357
Mailing Address - Country:US
Mailing Address - Phone:614-621-0101
Mailing Address - Fax:
Practice Address - Street 1:285 E STATE ST STE 360
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4357
Practice Address - Country:US
Practice Address - Phone:614-621-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005556RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant